A 57‑year‑old female presented with a 13 year history of diabetes. Due to the failure of oral hypoglycemic agents (OHAs) in controlling her sugar levels, for the last 3 years, she was treated with biphasic insulin aspart 30/70. She was a very frequent flier, a regular swimmer and socially very active, and this led her to have irregular meals. Hence, she often go into frequent hypoglycemia and during the last 6 months the patient’s average blood glucose level during fasting were 170 mg/dL and postprandial glucose levels varied from 230 to 280 mg/dL. Even after high sugar levels, she fortunately had normal kidney functions. Patient was able to afford an insulin pump, so she was put on one. With the pump, her blood glucose was in control and patient was happy. However she soon realized the limitation of carrying it everywhere she went.
These were the true feelings of a patient who was very active while she was on an insulin pump. The physician, after discussing with the patient, started her on insulin degludec and lifestyle modification, especially the diet component. Patient understood these problems and followed the diet. She followed the dietary modification and over 2 months of time, fasting blood glucose was 110 mg/dL, post meals values were around 180 mg/dL. She had only one episode of minor hypoglycemia which was due to delayed meal. The doctor later reduced degludec from 44 U to 40 U and blood glucose was still improving without any episode of hypoglycemia in the last 3 months. The outcome of this case is that with this therapy and dietary modification, a desired level of blood glucose can be achieved, without hypoglycemic risk.
This case study reminds me of many patients that I take care of while working at a local Medical surgical/Ortho floor at a local hospital. Almost daily I have at least one or more patients with Diabetes. I always assess and educate on how much the patient and family knows about Diabetes and risk factors.
Does the patient lifestyle interferes with her Diabetes, does she eat adequate meals, and is she compliant with medications?
The PICOT format is a way to develop a clinical question that lends itself to searching for evidence.
P= Population of Interest: Patient hospitalized frequently with hypoglycemic episodes.
I= Intervention of Interest: Patient teaching and education with home medication regimen, keeping scheduled doctor visits to stay updated, and eating 5 to 6 small meals per day to help prevent hypoglycemic episodes.
C= Comparison of Interest: Compare the treatment and discharge planning and teaching prior to current hospitalizations.
O= Outcome of Interest: Compliance of recommended treatment and follow through with discharge instructions and plan.
T= Time: Goal 30 days with no readmissions to the hospital for the same medical diagnosis-Diabetes.
For the patient to be successful she needs adequate and reliable resources to refer to in order to stay compliant and understand clearly on what are expected to prevent hypoglycemic episodes and frequent hospital visits. I f she has a friend or family member that would be willing to take part of her pal of care, it probably would motivate her to stay on track.
Reference:
www.cdc.govLinks to an external site.
Kumar, S. (2015). Type 1 diabetes mellitus-common cases. Indian Journal Of Endocrinology & Metabolism, 19S76-S77. doi:10.4103/2230-8210.155409
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